Clinical Financial Counselor

Scheduling/Coordination of Care
• Arranges the coordination of care with associated services at UF Health Shands, including the scheduling and pre-certification of all OR surgeries. This will include, but is not be limited to coordinating scheduling history and physical, pre-orthognathic work-up, and pre-surgical anesthesia appointments.
• Responsible for scheduling history and physical, pre-orthognathic workup appointments, diagnostic testing (MRI, CT scan, etc.) for both clinical and hospital grade requests.
• Responsible for posting OR cases on the SNAP board. 
• Responsible for updating the faculty Outlook calendars with OR cases. 

Financial Counselor
• Interview and counsel patients who will or have been treated in Oral and Maxillofacial Surgery and Center for Implant Dentistry to determine financial status and/or insurance coverage. 
• Verify insurance coverage for each patient and determine if services to be provided are covered and/or non-covered according to individual insurance policies.
• Verify account information in our computer system to ensure accuracy and update accounts as necessary. 
• Print proposal treatment plans for patients, knowledge of electronic billing, and print dental claim forms. 
• Responsible for entering treatment plans and charges into the system.
• Responsible for communicating with various insurance companies to obtain all inpatient and outpatient surgery authorization approvals.
• Works with Medicaid Portals for direct billing of all Medicaid dental or medical billing for the department.
• Determines patients who are covered by HMO, PPO, or Worker’s Compensation. 
• The incumbent will insure that each HMO, PPO or Worker’s Compensation visit is pre-certified. 
• Verifies patient’s insurance information on Availity, MMA Medicaid plans, and commercial plans. 
• Determines deductible, co-payment and extent of coverage. 
• Notifies patients of any deductibles due and/or any co-payment not covered by their policy. 
• Notifies students, residents, and faculty of services which are authorized and monitors treatment plan to ensure that all procedures are performed according to agency guidelines. 
• Notifies students, residents and faculty of the amount of payment to be collected from the patient prior to treatment being provided.
• Gather and verify copies of the patient’s insurance card and completes all forms required by third party payers. 
• Inputs insurance information into the computer system to ensure correct billing for treatment provided.
• Create medical record number for dental patient in the UF Health Shands Epic scheduling network system. 
• Responsible for emailing residents the CPT codes, DX codes, and surgery dates to enter an Epic encounter to create the OR case.

Answering OMFS Financial Office Phone lines. Assisting caller with financial questions regarding their accounts with both the oral surgery resident clinic and implant center (as needed).

Assist with department insurance explanation of benefits review for posting accuracy, providing requested information timely and efficiently, claims filing in Inovalon, submitting adjustment and refund requests, as needed

Other duties as assigned. 

• Knowledge of general office procedures and practices
• Working knowledge of basic math
• Able to plan, organize and coordinate work activities
• Able to follow instructions, written and verbal
• Able to communicate effectively
• Able to establish and maintain effective working relationships with others
• Able to review data for accuracy and completeness
• Knowledge of dental and medical terminology (basic terms at least)